Obama’s Health Care Speech

We fact-check the president's address to Congress and the nation.

Summary

President Obama’s prime-time address to Congress and the nation on health care prompted a Republican congressman to shout “you lie!” Did he? Here’s what we’ve found:

Obama was correct when he said his plan wouldn’t insure illegal immigrants; the House bill expressly forbids giving subsidies to those who are in the country illegally. Conservative critics complain that the bill lacks an enforcement mechanism, but that hardly makes the president a liar.

The president said “no federal dollars will be used to fund abortions.” But the House bill would permit a “public option” to cover all abortions, and would also permit federal subsidies to be used to purchase private insurance that covers all abortions, a point that raises objections from anti-abortion groups. That’s true despite a technical ban on use of taxpayer dollars to pay for abortion coverage.

The president repeated his promise that his plan won’t add “one dime” to the federal deficit. But legislation offered so far would add hundreds of billions of dollars to the deficit over the next decade, according to the Congressional Budget Office.

Obama said his plan won’t “require you or your employer to change the coverage or the doctor you have.” It’s true that there’s no requirement, but experts say the legislation could induce employers to switch coverage for millions of workers.

Correction, Sept. 16: We originally reported that Obama had "overstated somewhat the degree of concentration in the insurance industry," but we now have retracted that criticism. For a full discussion of why, please see our Sept. 16 FactCheck Wire post: "Retraction: Health Insurance Market Concentration."

Analysis

The president addressed a joint session of Congress Sept. 9, and the event was televised nationally.

Illegal Immigrants

Obama said that his proposal would not cover illegal immigrants, a remark that prompted Republican Rep. Joe Wilson of South Carolina to shout "You lie!"

Obama: There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I’m proposing would not apply to those who are here illegally.

The president is correct: The House bill contains a section (Sec. 246) titled "NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS," which states: "Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States."

However, conservative critics object to a lack of specific enforcement measures in the bill. They argue that the lack of a specific verification mechanism constitutes a loophole that would allow illegal immigrants to get benefits despite the legal prohibition. Republican Rep. Dean Heller of Nevada proposed an amendment to the bill that would have required the use of the Systematic Alien Verification for Entitlements program to check the immigration status of anyone applying for federal coverage or affordability credits. SAVE is the program used by Medicaid and similar entitlement programs. That amendment was voted down along party lines by the House Ways and Means Committee.

Republicans have a point here: More could be done to enforce the ban. But it’s worth remembering that, as a spokesperson for the American Immigration Lawyers Association told us, attempting to get a health care credit would have legal repercussions. "Making a fraudulent claim to an entitlement program when you’re not actually entitled to it would have serious consequences for any person," the spokesperson told us, "but especially if it’s considered a false claim to citizenship, that would have serious immigration consequences that could ultimately lead to deportation." And Rep. Wilson certainly was out of bounds to call the president’s statement a "lie." He later issued a statement apologizing for his "inappropriate and regrettable" comments.

Abortion

The president insisted that no federal money would pay for abortions:

Obama: [U]nder our plan, no federal dollars will be used to fund abortions.

The truth of that depends on what is meant by “federal dollars.” Actually, as we’ve written before, under Democratic legislation now before Congress, the “public option” would cover abortions in cases of rape, incest or threat to the life of the mother and could cover all abortions if the administration chooses, and as Obama once promised. Private insurance plans purchased with the help of federal subsidies to low- and moderate-income workers also could cover all abortions, as many, if not most, private plans do today.

Under an amendment adopted by a House committee, abortions would be paid for by the "public option" only with money collected from policyholders in the form of premiums, not with money collected from taxpayers. But is money collected by the government and paid out to abortion providers by the government “federal dollars"? The anti-abortion side says yes. And the same goes for federal subsidies given to low- and moderate-income persons to help them buy insurance. If they use those dollars to buy private policies that cover all abortions, does that mean “federal dollars” go to fund abortions? Again, abortion foes say yes.

The advocates of abortion rights argue otherwise. They say the House bill would be an extension of longstanding policy under the Hyde amendment, which forbids use of federal taxpayer dollars to fund Medicaid abortions except in cases of rape, incest or threat to the mother’s life, but also allows states to use their own Medicaid money to fund other abortions (and 17 of them do). In any case, the matter is not so simple or clear as the president would like it to seem.

Deficit-Neutral

The president repeated his promise to fully pay for the plan.

Obama: I will not sign a plan that adds one dime to our deficits – either now or in the future. Period.

Up until now, that’s been a promise in search of fulfillment. As we reported earlier, the nonpartisan Congressional Budget Office has found that Democratic plans in the House and Senate both would add hundreds of billions of dollars to the federal deficit over the coming decade.

In his speech, the president reduced the price tag, saying "the plan I’m proposing will cost around $900 billion over 10 years." That’s about $100 billion less than what the CBO said the House bill would cost. And the president embraced a tax on expensive employer-paid health plans, something he’s resisted in the past. He also said there will be a provision in this plan that "requires us to come forward with more spending cuts if the savings we promised don’t materialize."

But it remains to be seen whether the CBO’s budget experts will agree that the plan would be fully paid for. For that, they’ll need to see more specific details.

"Public Option"

The president misstated a few details on the proposed "public option":

Obama: It would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance.

In fact, under the House bill, the new federal plan would be open to anybody who buys insurance on his or her own, whether or not the person currently has coverage. It also would be open to employees of small businesses, defined in the House bill as those with no more than 20 employees, whether or not those employees are currently covered by another plan. It’s true that the "public option" is aimed at the uninsured, but they wouldn’t be the "only" ones who could buy it.

It is true, as Obama said, that "no one would be forced to choose it." But experts say that it might well have an "impact" on some of those who currently have insurance. Obama noted that "based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up" for the federal plan. The CBO did say that only 11 million to 12 million Americans would join the public plan under the original House bill. But estimates from the Lewin Group, a subsidiary of UnitedHealth Group that says it operates with editorial independence, were higher, at 33.6 million. Lewin’s estimate triples when it looks at what might happen if the federal plan were available to everyone, a possibility the House bill leaves open. The House bill as amended by the Energy and Commerce Committee, however, sets up a "public option" that won’t affect nearly as many people. The CBO estimates that an insignificant number would switch under that plan, and Lewin’s estimate drops to 20.6 million, if the plan were open to all.

Choosing Words Carefully

Some of the president’s factual claims, while accurate, were notable for his careful wording.

Obama: There are now more than 30 million American citizens who cannot get coverage.

Obama: [N]othing in this plan will require you or your employer to change the coverage or the doctor you have.

It’s true that no Democratic legislation would “require” workers or employers to change coverage, though some existing plans may have to be upgraded to meet new federal minimum standards if, for example, they fail to cover preventative screenings.

Obama has become more cautious in his wording since an Aug. 15 appearance when he said "if you like your health care plan, you keep your health care plan." That won’t always be true. In fact, as we noted at the time, some firms are likely to buy different coverage for their workers than they have now, or simply drop coverage and pay a penalty instead, leaving workers to buy their own private coverage or go on a new federal insurance plan. The CBO estimated that 3 million who now have employer-provided coverage would lose it under the House bill, as their employers find that paying the penalty is cheaper than providing coverage. The CBO also said these employers would likely have lower-wage employees eligible for federal subsidies to help them purchase insurance.

Obama: [Republicans] just this year supported a budget that would essentially have turned Medicare into a privatized voucher program.

We slammed the Democratic National Committee for running an ad that said Republicans voted to "abolish Medicare." The president was talking about the same vote, and characterized it much more accurately. The budget resolution supported by most House Republicans would have preserved the current system for everybody age 55 or over, but when younger workers reached retirement age they would have been given a choice of government-approved private insurance plans and a government subsidy to pay most of the premiums.

However, Obama continued to make one factual claim we have repeatedly found to be wrong:

Obama: [T]hose of us with health insurance are also paying a hidden and growing tax for those without it – about $1,000 per year that pays for somebody else’s emergency room and charitable care.

That figure comes from a study by Families USA estimating the effect on premiums of uncompensated care, which is care that is provided to the uninsured but not paid for. But that group advocates vigorously for wider government health coverage.The figure is not supported by the Kaiser Family Foundation or the Congressional Budget Office. Both have reported that uncompensated care actually leads to lower hospital profits, not higher premiums. KFF’s estimate of the amount of uncompensated care shifted to premium-payers works out to about $200 per family per year, not $1,000.

Overall, Obama got good marks for clarity and accuracy from at least one expert who’s sometimes been critical. John Sheils, senior vice president of the Lewin Group, which has analyzed the House bill and health care proposals, told us that there was “a lot of stuff you could quibble with” in the president’s speech, but overall he was “impressed” with the way Obama explained a “hugely complicated issue.” “I think in the main of it, I think he did pretty well.”

– by Brooks Jackson, Jess Henig, D’Angelo Gore and Lori Robertson

Update, Sept. 18: For a false claim that we at first missed, see our Wire items “Sweet: Another Stretch by Obama” and “Too Good to Check?” The president said an Illinois man going through chemotherapy had died because of delayed treatment after his insurance company canceled his policy because of “reported gallstones that he didn’t even know about.” But the truth is that the man got his treatment after the coverage was reinstated, and lived for over three more years.

Clarification, Oct. 6: We originally said that the SAVE program checks the "citizenship" of applicants for federal aid. It technically checks immigration status.

Ask FactCheck

Q: Will people living in the U.S. illegally receive “amnesty bonuses” because of President Obama’s executive actions on immigration? A: There is no automatic payment, but some working immigrants could claim up to four years of earned income tax credits if they meet eligibility requirements.